Treatment Options for Stomach Ulcers

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Often we consider ourselves in good health despite having some concerns. A seemingly minor health worry like a stomach problem, however, may have major implications on our day-today lifestyle. Stomach problems may not make headlines as life threatening health issues but they can be painful and dramatically influence our social lives by dictating when and what we consume and how we feel on a daily basis. They can potentially lead to long-term issues, if left unattended.

Estimates by the American College of Gastroenterology indicate that over 60 million Americans suffer from heartburn and 20 million Americans will suffer from an ulcer during their lifetime. Stomach ulcers are more common after 60 years of age and are more common in women.( n1)

Peptic Ulcers and Their Causes
The stomach's natural defense mechanism is a protective lining of cells with an overlying thick coat of mucus. Constant mucosal secretions are intended to protect against irritation or challenge. Additionally, a large flow of blood through the stomach lining aids in cellular renewal and repair. Occasionally these defenses are overwhelmed and the stomach's natural acidic secretions continue to work against the healing process.

Ulcers start as an irritation in the lining of the stomach and can occasionally lead to a perforation. Common ulcer symptoms are heartburn or pain just below the rib cage while less common symptoms are nausea or vomiting. Ulcer pain is often experienced between meals or at nighttime and is relieved by eating or taking over-the-counter antacids.

In the past it was thought stress was the most common cause of ulcers. Today science has identified some specific factors thought to contribute to poor stomach health and gut injury. One of the main causes is the bacteria Helicobacter pylori (H. pylori) which is a major factor in the development of peptic ulcers. In global terms, it is estimated that H. pylori is present in over half the world's population, although in the u.s. its prevalence is estimated at around 20 percent. Many people can tolerate this bacterium without ill effects or other symptoms and a simple blood test can determine its presence. Interestingly, not everyone with H. pylori develops ulcers and as the prevalence of the bacteria declines, it is clear that other factors, such as differences between individuals and how their bodies fight injury, are probably also important.

Non steroidal anti-inflammatory drugs (NSAIDs)are another major contributing factor to ulcers. The New England Journal of Medicine identified NSAIDs as the second leading cause of ulcers in the United States.( n2) Many pain relievers such as aspirin and aspirin-like compounds (ibuprofen and naproxen sodium) are a part of this broad category of stomach irritants. One study reports that approximately 50 percent of patients who regularly take NSAIDs have some level of gastric erosion and as much as 15-30 percent have ulcers.( n3) For many individuals the decision to remain on low-level pain medications for the treatment of age-related health issues comes at the price of disruptions and injury to stomach lining. This may explain the higher prevalence of ulcers in those over 60.

Other factors that can lead to digestive problems and ulcers include smoking, alcohol and excessive consumption of fatty foods or acid foods and beverages like coffee and some fruit juices. These lifestyle indiscretions can compound an already overtaxed defense system. It is also believed oxidative stress plays a role in cellular integrity and poor stomach health.

Treatment Considerations
The traditional battery of treatments for stomach ulcers has involved a defensive strategy of suppressing or neutralizing the stomach acid. By reducing the acidity in the stomach, the irritation of the wound and the discomfort is reduced. Acid suppression currently involves two categories of drug treatment; H2 Receptor Antagonists and Proton Pump Inhibitors. The general mode of action of these compounds is to chemically block the stimuli that trigger acid production while preventing the release of acid into the stomach. These same acid blockers can also reduce heartburn symptoms and increase healing rates but questions surrounding these compounds still remain.

Acid blockers on their own will not single-handedly inhibit H. pylori and also require additional antibiotic treatment. Unfortunately, many peoples' symptoms return after stopping treatment, leading them to years of drug therapy. Additionally, many people would rather not take drugs that alter the normal digestive process and possibly lead to increased health consequences.

Prevention
Clearly the focus of the past has been on treatment through acid suppression rather than prevention, as the supplement and natural product category has been particularly devoid of gastrointestinal products for stomach ulcers. Prescription and OTC drugs have dominated treatment in this niche but an interesting new compound called zinc-carnosine, a chelated or chemically joined molecule combining the trace mineral zinc and L-carnosine shows promise for its powerful antioxidant and wound healing properties. The zinc-carnosine complex was developed and patented by Hamari Ltd. of Osaka, Japan, a life-sciences oriented chemical company.

Supporting the stomach's integrity and natural defense mechanism in the form of prevention is the target of this new ingredient soon to be incorporated into dietary supplements. With human and animal trials demonstrating safety and efficacy, the science supporting this ingredient suggests a new approach to a challenging health concern.

The Clinical Data
As a prescription product in Japan since 1994, one of the human clinical trials have reported "remarkable improvement" of symptoms and objective criteria in as many as 70 percent of subjects after eight weeks of use.( n4) This includes symptoms such as heartburn, belching and abdominal distention.

Even more telling were the endoscopic healing rates, reported as high as 65 percent improvement in ulcers after eight weeks of zinc-carnosine use.( n5) Endoscopy is the technique used by physicians to insert a monitor into a subject allowing the researchers to see results inside the stomach.

The Components
Both L-carnosine and zinc have common pharmacological properties such as antioxidant, membrane stabilizing, immunomodulating and tissue repairing effects. They have also been independently investigated and appreciated for their anti-ulcerogenic effects in lab tests.

L-carnosine is a di-peptide composed of the two essential amino acids ?-alanine and L-histidine. L-carnosine is naturally present in our bodies in muscle and connective tissue and is most often known for its anti-aging properties. In fact, it is so commonly abundant in meat protein that one can easily consume several grams a day in a single serving of chicken breast.

Zinc is an essential trace mineral element which plays a key role in numerous physiological reactions. Research demonstrates that zinc is a key factor in immune function, reproduction, appetite, growth and wound repair. In the human body, zinc is found at the active centers of over 300 enzymes. Foods naturally rich in zinc include beef, cheese, liver and milk powder. Dietary decisions, especially for vegetarians and women, often reduce the opportunity for adequate zinc intake, easily falling below the RDA of 15 mg.

The Synergy
Consumer products often combine ingredients into a single formulation. As an example, glucosamine and chondroitin are often paired together in a single product. While these combinations make sense for their convenience, the advantage is rarely more than the cumulative benefit of each single component. When L-carnosine is complexed with zinc, the unique properties of the molecule offer benefits greater than that of zinc physically mixed or ingested with L-carnosine. This synergistic effect was demonstrated in a recent study involving laboratory animals.( n6)

The exact chemical mode of action is not fully understood but the result is that zinc-carnosine dissolves in the stomach and adheres to the ulceration or wound on the stomach lining more effectively than other forms of zinc complexes. At this point the antioxidant, membrane stabilizing and wound healing properties take effect promoting mucus secretions and supporting the mucosal barrier, the stomach's natural defense mechanism. It has also been shown to inhibit the presence of the H. pylori bacteria.( n7)

Summary
Digestive complaints, including ulcers, can potentially become chronic long-term problems. Primary causes of stomach ulcers have been identified as the H. pylori bacteria and the increasing use of NSAIDS. As society ages an increasing number of people will take medications such as pain relievers which can cause side effects such as ulcers, thus increasing the need for natural products such as zinc-carnosine.

One theory regarding the cause of peptic ulcers considers that ulcers develop because of a loss of balance between offensive factors such as pepsin and defensive factors such as mucus and the mucosal barrier. Progress has been steady and valuable on the defensive side of this equation with the development of acid suppressors, but perhaps for the first time we can consider adding to the offensive side of the equation. Clinical data supporting zinc-carnosine looks promising as an additional tool to achieve balance and optimum gastrointestinal health.

As with any dietary supplement, one should learn as much as possible about the ingredient(s) and consult with a health care provider.

References:
(n1.) American College of Gastroenterology. Web site www.acg.gi.org

(n2.) Wolfe, M. M. et al. N Engl J Med (June 1999). Vol. 340 pp. 1754-6.

(n3.) Laine, L., Gastroenterolog. (Feb. 2001). Vol. 120(3) pp. 594-606.

(n4.) Morise, K., et al. Jpn Pharmacol Ther (1992). Vol. 20(1) pp. 235-44.

(n5.) Hayakawa, A. et al. Jpn Pharmacol Ther (1992). Vol. 20(1) pp. 255-64.

(n6.) Korolkiewicz, R. et al. Dig Dis Sc (1999). Vol. 45(6) pp. 1200-9.

(n7.) Biochemistry (Moscow) (2000). Vol. 65:7 pp. 751-6.

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By Jennifer Nissen, N.D.

Jennifer Nissen, N.D. is manager of nutritional research at LaneLabs USA, Inc. She conducts educational seminars for consumers and speaks at alternative health conferences for retailers and physicians. Dr. Nissen has been interviewed on radio shows and several television news programs nationwide. Dr. Nissen also evaluates new product research and oversees new product development. She received her degree from Bastyr University in Seattle, Washington. She is a member of the American Association of Naturopathic Physicians and has served as the president of the Rhode Island Association of Naturopathic Physicians.

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